Understanding Dental Lasers: They're Not Only for Frenectomies.

Often, clinicians consider lasers in dentistry only as a tool for doing frenectomies. Unfortunately, despite the dental laser having more than 30 years of clinical application, many practitioners and educators may lack an extensive understanding of this valuable instrument. This article highlights the scientific basis and indications for the use of lasers in dentistry.

Thermographic Changes During Soft Tissue Incisions with Diode Infrared Lasers.

Objective: This study aimed to demonstrate temperature changes and heat transfer patterns in soft tissues when using infrared (IR) diode lasers, utilizing thermographic techniques. Methods: Bovine tongue slices (5 mm thick) were placed between two glass slides at 11 cm from a thermographic camera. Twenty-two centimeter-long incisions were made along the soft tissue parallel to the camera capture field. Incisions were performed using the 970 and 980 nm lasers (continuous wave, 2-watt, 320 µm-thick glass initiated, and noninitiated fiber tips, 30-sec irradiation). The maximum temperature changes in oC (ΔT) and the vertical and lateral heat transfer (in mm) were recorded for 30 sec, using the thermographic images captured using the IR camera. The ΔT and the amount of lateral and vertical heat distribution were measured in 10-sec intervals for a 30-sec irradiation period. A repeated analysis of variance (ANOVA) (p < 0.05) statistical test was used to analyze the statistical differences between the average ΔT and heat transfer patterns between the initiated and noninitiated lasers. Results: The maximum ΔT for the 970 nm diode laser with initiated tips at the 30-sec mark was 17.81 ± 11.48, while the maximum ΔT for the 980 nm diode laser with initiated tips was 13.24 ± 6.90 (p = 0.041). Statistically significant differences between the vertical and horizontal heat transfer patterns were noted between the initiated and noninitiated diode lasers. The 980 nm diode laser with initiated tips proved to have statistically significant greater vertical and lateral heat transfer when compared to the 970 nm diode laser. The 970 nm diode laser with noninitiated tips proved to have a statistically significant higher heat distribution when compared to the 980 nm laser with noninitiated tips. Conclusions: Different near-IR lasers present differences in lateral heat and tissue penetration, using initiated or noninitiated fibers, and due to these differences, power settings and irradiation period must be considered to avoid risks due to overheating.

Dental Diode Lasers for Implant Uncovering: A Case Series.

Diode lasers are increasingly being utilized as an alternative to conventional soft tissue surgery. Diode lasers originally referred to wavelengths ranging from 810 to 980 nm, but a visible diode laser with a 445-nm wavelength has emerged as an additional wavelength for soft tissue surgery. The goal of this case series was to demonstrate the clinical results of both visible and near-infrared (NIR) wavelengths when utilized for stage-two implant surgery. Ten patients with 23 implants were treated at Stony Brook University, Department of Periodontology, for implant uncovering using both visible and nonvisible (NIR) diode lasers. The uncovering was performed utilizing 445-, 970-, and 980-nm wavelengths at a power setting of 2 W in either continuous or pulsed modes. The fiberoptic tips were initiated using blue articulating paper. Either topical benzocaine or infiltration anesthesia was utilized prior to soft tissue removal with the initiated tip. All patients healed uneventfully without any postoperative complications. Visible and NIR diode lasers provide an alternative and safe method to uncover submerged implants at stage-two surgery.

Clinical Outcomes of Metal-Ceramic versus Metal-Acrylic Resin Implant-Supported Fixed Complete Dental Prostheses: A Systematic Review and Meta-analysis.

PURPOSE: To compare the clinical outcomes of metal-ceramic vs metal-acrylic resin implant-supported fixed complete denture prostheses (IFCDPs). MATERIALS AND METHODS: An electronic literature database search was conducted in the CINAHL, EMBASE, PubMed, and Web of Science databases. Additionally, a manual search of the literature was performed. Studies conducted in edentulous human subjects comparing clinical outcomes of metal-acrylic resin IFCDPs to those of metal-ceramic IFCDPs were included if quantitative outcomes for the following variables were reported: implant failure, prosthetic failure, incidence of peri-implantitis, incidence of peri-implant mucositis, incidence of peri-implant mucosal recession, prosthetic complications, and any patient-centered outcomes. Data from included studies were pooled to estimate effect size. RESULTS: Five studies met the inclusion criteria. A quantitative analysis was possible for risk of implant failure, prosthesis failure, and incidence of peri-implantitis. Meta-analysis showed no statistically significant differences in the risk of implant or prosthesis failure between the two groups. However, meta-analysis showed a significantly greater risk of developing peri-implantitis at the implant level in the metal-acrylic group when compared to the metal-ceramic group (risk difference = 0.069; 95% CI = 0.028 to 0.06; P = .001; fixed-effects model). Furthermore, descriptive analysis of the literature indicated a higher incidence of other biologic complications such as peri-implant mucositis and peri-implant mucosal recession, as well as prosthetic complications such as abrasion and veneer fracture, in metal-acrylic resin IFCDPs compared to metal-ceramic IFCDPs. CONCLUSION: The available evidence suggests that a higher incidence of biologic and prosthetic complications, including a higher risk of peri-implantitis, are present with metal-acrylic resin IFCDPs compared to metal-ceramic IFCDPs.

Biological Characterization, Properties, and Clinical Use of a Novel Homeopathic Antiseptic Oral Recovery Kit: A Narrative Review.

Most available antiseptic solutions have strong antibacterial effects, but many also possess major cytotoxic effects on gingival fibroblasts, osteoblasts, osteoprogenitor cells, and/or epithelial cells. A novel VEGA Oral Care Recovery Kit (StellaLife) consisting of 16 active ingredients that are monographed in the Homeopathic Pharmacopeia of the United States (HPUS) has gained tremendous momentum as a replacement for more cytotoxic oral rinses such as chlorhexidine. While accumulating evidence has thus far supported its use, little of the gathered data have fully described the properties of the oral formulation. Therefore, the aim of the present review article was 3-fold. First, a biological characterization regarding the active ingredients found in StellaLife Recovery Kit including their biological properties was assessed in 4 predominant categories; 1) antimicrobial resistance, 2) accelerated wound healing, 3) pain management control, and 4) anti-cancer properties. The second aim of this review article was to assess both fundamental and clinical research to date comparing VEGA oral rinse (StellaLife) to the more commonly utilized CHX for differences regarding their effect on decreasing bacterial loads as well as cell viability, survival, proliferation, and expression of both regenerative cytokines and inflammatory markers. Lastly, clinical case examples are presented describing the use of StellaLife remedies in a variety of clinical situations. These include but are not limited to wisdom-tooth extraction, extraction site management, dental implants and ridge augmentation, soft-tissue grafting procedures, frenectomies, and also temporary relief of dry sockets, dry mouth, aphthous ulcers, mucositis, lichen planus, among others. In summary, findings from the present review article provide evidence from basic laboratory experiments that validate clinical studies supporting the use of the StellaLife oral rinse regarding its superior biocompatibility and wound healing properties when compared to common antiseptic solutions such as CHX.

Thermal Effects of Diode Laser-Irradiation on Titanium Implants in Different Room Temperatures In Vitro.

Objective: The aim of this study was to determine the thermal effects of diode laser irradiation on titanium implants. Methods: An implant (3.5 × 11 mm) was placed into a bovine bone block. A three-wall intrabony defect was created to simulate peri-implant defect. Two thermocouples were secured to the apical and coronal surfaces to measure temperature changes (ΔT) during irradiation. The block was placed in a 37°C water bath and at room temperature (21°C). The defect was irradiated with different diode lasers (fiber 300 µm), while the coronal part of the implant was slightly emerging from the water. While the laser tip was positioned parallel to the implant, the defect was irradiated for 30 sec at 2 W in continuous and pulsed mode. Twenty laser irradiations were performed for each laser wavelength for assessment of ΔT. The linear mixed model was used for comparative statistics. Results: The 980 nm pulsed laser resulted in the highest ΔT (°C) at the coronal (22.45 ± 2.1/14.15 ± 0.13) and apical level (5.4 ± 0.56/3.56 ± 0.35) when this laser was used in both room temperature and water bath conditions, respectively. Similarly, highest ΔT (p < 0.0001) for the 810 nm was 14.3 ± 1.6/12.51 ± 0.63 and apical 3.42 ± 0.52/2.58 ± 0.25, for the 970 nm was 13 ± 1.4/9.93 ± 0.47 and apical 2.89 ± 0.19/2.01 ± 0.19 compared to the 940 nm laser coronally 10.1 ± 0.6/9.19 ± 0.35 and apically 1.67 ± 0.34/1.80 ± 0.17. The coronal part of the implant surpassed the critical threshold of 10°C when irradiated with each of the lasers in the room temperature conditions. Conclusions: Within the limitations of the study, the 940 nm laser seems to control better the risks of overheating during implant irradiation.

Drug-associated bone resorption with potential dental and implant implications.

Every year more and more innovative pharmacological agents are introduced medicine, to treat systemic diseases. Due to these rapid and recent advancements, many patients are receiving treatment with a high variety of drugs, such as selective serotonin reuptake inhibitors, bisphosphonates, tumor necrosis factor (TNF)-α inhibitors, cyclosporine, and steroids. Since implant and osseous surgery are common treatment modalities used, within dentistry, it is of critical important to acknowledge and discuss the potential effects of selective serotonin reuptake inhibitors, bisphosphonates, TNF-α inhibitors, cyclosporine, and steroids, on bone healing. The present paper discusses the possible detrimental ramifications and risks these drug classes may have on bone healing.

Comparing the Use of Diode Lasers to Light-Emitting Diode Phototherapy in Oral Soft and Hard Tissue Procedures: A Literature Review.

Objective: In dentistry, patient and physician adoption of diode lasers and light-emitting diodes (LEDs) continues to increase as research indicates that diode lasers and LEDs may be used for surgical and nonsurgical procedures. The goal of this literature review was to critically analyze randomized controlled trials and experimental trials to provide evidence-based recommendations on the therapeutic uses of diode lasers and LEDs in oral applications based on published efficacy and safety data. Methods: A literature review was performed of published literature on patients receiving periodontal and oral surgery treatment that included the use of diode lasers and/or the use of LED phototherapy to determine if the outcomes of phototherapy were superior to conventional therapy and if one form of phototherapy was superior to the other. Results: Eighteen original clinical trials and experimental studies were suitable for review. The diode laser was presented as an effective tool in soft tissue management due to its cutting precision, incision depth, analgesic effects, and elimination of bacterial load and in periodontal applications for probing depth reduction when used as an adjunct to scaling and root planing (SRP). LEDs also served as an effective tool for pain management, wound healing, and efficacy when used as an adjunct to SRP. Other than one study, all the available studies reviewed were either evaluating the efficacy of diode lasers or LEDs, but not both. Therefore, the results for determining the more effective tool were inconclusive. Conclusions: According to existent data, diode lasers and LEDs are equally effective tools for the phototherapy in periodontology and oral surgery. Although fewer studies exist examining the use of LED for phototherapy, the studies all revealed positive results. Further clinical comparative investigations utilizing both diode lasers and LED are needed to determine superiority of this application for periodontal management and oral surgery.

Ti Ions Induce IL-1ß Release by Activation of the NLRP3 Inflammasome in a Human Macrophage Cell Line.

The aim of the present study was to investigate whether titanium (Ti)-induced release of interleukin (IL)-1ß acts through the assembly of the NACHT, LRR, and PYD domain-containing protein 3 (NLRP3) inflammasome. In addition, we examined whether particulate Ti or TiO2 activates the same intracellular pathways with the assembly of the NLRP3 inflammasome as Ti ions. Ti ions are known to induce IL-1ß maturation and release by the formation of metal-protein aggregates. Wild-type THP-1 (wt.) cells and NLRP3- and ASC- (apoptosis-associated speck-like protein containing caspase recruitment domain (CARD)) knockdown cells were used in the experimental analyses. Macro- and nanoparticles (NPs) of both Ti and TiO2 were used as test agents. IL-1ß release as a biomarker for inflammasome activation and cell viability was also analyzed. Periodate-oxidized adenosine triphosphate (oATP) was used to attenuate downstream signaling in NLRP3 inflammasome activation. Cellular uptake of Ti was examined using transmission electron microscopy. Cells exposed to the Ti-ion solution showed a dose-dependent increase in the release of IL-1ß; conversely, exposure to particulate Ti did not result in increased IL-1ß release. Cell viability was not affected by particulate Ti. Knockdown cells exposed to Ti showed a statistically significant reduction in the release of IL-1ß compared with wt. cells (p < 0.001). Cellular uptake was detected in all Ti mixtures, and aggregates with various structures were observed. Ti ion-induced release of bioactive IL-1ß in THP-1 cells involves the assembly of the NLRP3 inflammasome.

Thermal Penetration Depth of Pulsed Lasers in Gingival Tissues: An In Vitro Study.

Background: With laser irradiation emerging as an adjunctive treatment utilized in nonsurgical periodontal therapy, it is important to understand the variance of penetration depth among the different laser wavelengths. Purpose: To evaluate the thermal penetration depth, as a photothermal effect, of carbon dioxide (CO2)-, erbium: doped yttrium-aluminum-garnett (Er:YAG)-, and erbium, chromium: yttrium-scandium-gallium-garnett (Er,Cr:YSGG)-lasers on the bovine gingiva in an in vitro model. Methods: Four mandibles from freshly slaughtered cows were utilized in this study. Buccal and lingual root debridement was provided using three different laser wavelengths, all in pulsed settings. A CO2- (10,600 nm), Er:YAG- (2940 nm), and Er,Cr:YSGG- (2780 nm) were utilized to irradiate pockets of two mandibular posterior teeth in each group. Laser power output settings were set to 2 W. The posterior teeth were irradiated for 30 sec buccal and 30 sec lingual of each tooth for all selected treatment test groups. Instrumentation with curettes was performed as a control group. Gingival flaps, including the entire gingiva, were fixed in 10% formalin and stained via Elastin van Gieson. Sections were examined microscopically to evaluate thermal damage and statistically compared using mixed effect model with Tukey adjustment. Results: The CO2-laser irradiation presented a statistically significant lower mean compared to Er,Cr:YSGG-laser (p < 0.0001). Er,Cr:YSGG-laser had a higher penetration depth compared to Er:YAG-laser (p < 0.0001). There was no statistically significant difference found in penetration depth between CO2- and Er:YAG-laser irradiation. Conclusions: It can be concluded that all tested pulsed lasers had minimal penetration depth into the gingiva. However, the pulsed CO2- and Er:YAG-lasers presented lower thermal effects compared to Er,Cr:YSGG-laser in vitro.

In Vitro Toxicity of Bone Graft Materials to Human Mineralizing Cells.

Bone graft materials from synthetic, bovine, and human sources were analyzed and tested for in vitro cytotoxicity on dental pulp stem cells (DPSCs) and osteosarcoma cells (Saos-2). Raman spectroscopy indicated significant amounts of collagen only in human bone-derived materials, where the mineral to protein ratio was 3.55 ± 0.45, consistent with bone. X-ray fluorescence revealed tungsten (W) concentrations of 463 ± 73, 400 ± 77, and 92 ± 42 ppm in synthetic, bovine, and human bone chips, respectively. When these chips were added to DPSCs on tissue culture plastic, the doubling times after two days were the same as the controls, 16.5 ± 0.5 h. Those cultured with synthetic or bovine chips were 96.5 ± 8.1 and 25.2 ± 1.4 h, respectively. Saos-2 was more sensitive. During the first two days with allogeneic or bovine graft materials, cell numbers declined. When DPSC were cultured on collagen, allogeneic and bovine bone chips did not increase doubling times. We propose cytotoxicity was associated with tungsten, where only the concentration in human bone chips was below 184 ppm, the value reported as cytotoxic in vitro. Cells on collagen were resistant to bone chips, possibly due to tungsten adsorption by collagen.

Reducing errors in guided implant surgery to optimize treatment outcomes.

Clinical considerations and treatment criteria in implant placement are constantly evolving. Prosthetically driven implant surgery has become the standard of care to improve short and long-term functional and esthetic outcomes. Therefore, implant position and angulation are planned according to the available bone, anatomical structures, and the requirements of the future prosthetic superstructure. In parallel with these developments, significant progress has been made in data imaging and different software technologies to allow the integration of data within a digital file format. Digitalization in implant surgery enables optimal planning of implant position, as well as the ability to transfer this planning to the surgical field-a process defined as "computer-supported implant planning and guided surgery." The aims of the present review are as follows: (a) to critically appraise the indications and potential "added value" of guided implant surgery, elaborating the main differences between dynamic and static guidance; and (b) to discuss the most important clinical considerations relevant for the different steps of the workflow that might influence the surgical outcome and to offer recommendations on how to avoid or reduce process errors in order to optimize treatment outcomes.

Biological mechanisms underlying complications related to implant site preparation.

Implant site preparation is a critical stage of implant surgery that may underpin various complications related to implant surgery. This review discusses the latest available scientific information on risk factors related to implant site preparation. The role of the drilling process in relation to the density of the available alveolar bone, the effects of insertion torque on peri-implant osseous healing, and implant-related variables such as macrodesign and implant-abutment connection are all factors that can influence implant success. Novel information that links osteotomy characteristics (including methods to improve implant initial stability, the impact of drilling speed, and increase of the implant insertion torque modifying the bone-implant interface) with the appropriate instrumentation techniques will be discussed, as well as interactions at the bone-biomaterial interface that may lead to biologic complications mediated by implant dissolution products.

Diode Laser Light Scattering and Temperature Changes Due to Anesthesia Injection in Bovine Tongue Mucosa.

Background and objective: Diode lasers are used in periodontal therapy. Parameters such as wavelength and application mode can affect the laser/tissue interactions, quality of incision, and final outcomes. This study set out to assess the temperature changes in tissue when diode lasers are used for incisions on tissues injected with local anesthetics. Materials and methods: Incisions were made on the surface of bovine tongue parallel to the tongue axis (ex vivo). The tissue was divided into three groups (lidocaine, saline, and a control group with no infiltration). Irradiation was performed with 810 and 980 nm diode lasers. Trials were further divided using noninitiated and initiated tips. A microprobe thermocouple was placed to evaluate the temperature changes. Linear mixed-model with Tukey adjustment was used to make comparisons and p < 0.05 was denoted as statistically significant. Results: The overall group comparisons reveal that the control group mean rise in temperature is lower than both the lidocaine group (p < 0.0001) and the saline group (p < 0.0001). When combining the data in and across each group, the average temperature rise that occurred for incisions made with initiated tips was significantly lower than incisions made with noninitiated tips (p < 0.0001). Combining the data of tip initiation shows that incisions made with a 980 nm laser produced lower temperature changes, than incisions made with an 810 nm laser (p < 0.0001). Conclusions: Infiltration of water-based liquids, such as local anesthetics or saline, causes an increase in tissue temperature during irradiation, especially when noninitiated tips are used. In addition, temperature significantly rises with the use of the 810 compared with the 980 nm diode laser. Therefore, to avoid photothermal damage to the tissue, the use of initiated tips is encouraged and local anesthetics in conjunction with 810 nm diode lasers should be minimized.

Connective Tissue Graft vs Platelet-rich Fibrin in the Treatment of Gingival Recessions: A Randomized Split-mouth Case Series.

AIM AND OBJECTIVE: Coronally advanced flap (CAF) with connective tissue graft (CTG) has been considered the gold standard for obtaining complete root coverage. However, some limitations have been reported with the use of CTG, especially because it increases morbidity and leads to postoperative pain and bleeding. Recently, platelet-rich fibrin (PRF) has been used in periodontal plastic surgery for the treatment of gingival recessions (GRs). The aim of this study was to evaluate the outcome of PRF combined with a CAF (test) compared to de-epithelialized connective tissue graft (DeCTG) + CAF (control) for GR coverage. MATERIALS AND METHODS: Ten healthy patients exhibiting mandibular or maxillary Miller class I and II were treated with PRF + CAF or DeCTG + CAF. GR, probing depth (PD), and gingival thickness (GT) were evaluated at baseline, 6 weeks, and 28 weeks postoperatively. RESULTS: GR, PD, and GT differences between the test and control groups at 28 weeks were not statistically significant. GR was 3.30 ± 1.25 mm and 3.00 ± 1.63 mm (control vs test) group (baseline) and -0.10 ± 0.32 vs -0.20 ± 0.42 mm (7 months), respectively. CONCLUSION: Within the limitations of the present study, it can be concluded that localized gingival recessions could be successfully treated with CAF + PRF or CAF + DeCTG. CLINICAL SIGNIFICANCE: This study suggests that PRF membrane may be an alternative and valid graft material for treating localized gingival recessions Miller class I and II.

Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet Laser for Root Conditioning and Reduction of Postoperative Morbidity in the Treatment of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

Objective: This clinical trial evaluates the effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) root surface biomodification and laser harvesting of de-epithelialized gingival graft (DGG) on root coverage clinical outcomes and postoperative morbidity, and compares this to the conventional blade-harvested DGG method without Er,Cr:YSGG root surface biomodification in treatment of Miller's class I, II gingival recessions (GR). Background: The application of laser technology to enhance tooth root coverage clinical outcomes as well as the impact of laser on postoperative morbidity after harvesting autogenous soft tissue grafts requires further research. Methods: This study is a randomized, single-blinded controlled trial, including 24 volunteers with isolated GR defects. They were allocated into three treatment groups to receive one of the following three interventions: blade-harvested DGG (control group: B-DGG); Er,Cr:YSGG-harvested DGG and root surface biomodified [test 1 group: L-laser-harvested DGG (L-DGG)/laser root biomodification (LRB)]; and B-DGG and Er,Cr:YSGG root surface biomodification (test 2 group: B-DGG/LRB). Clinical and radiographic parameters were recorded at baseline (1 week before surgery) and 3, 6, and 9 months postoperatively. Results: Root coverage did not show a statistically significant difference between control and test groups. Statistically significant differences were found for Visual Analog Scale on the day of surgery and day 3 and 4 postoperatively, as well as pain medication on the day of surgery favoring the L-DGG group. Conclusions: The use of Er,Cr:YSGG laser in root surface biomodification improved root coverage outcomes at 9 months. Even these changes were not statistically significant from the control group; the L-DGG technique was associated with decreased postoperative morbidity in the palatal donor site.

Thermal Transfer on Splinted Implants During Diode Laser Irradiation In Vitro.

Objective: Laser irradiation is being used for treatment of peri-implantitis. Therefore, this study aimed to assess the heat transfer from laser irradiation on an implant-supported, metal-ceramic fixed prosthesis in vitro. Materials and methods: Two titanium implants were placed in artificial type I bone, and after abutment connection, a bridge was fabricated and cemented. A peri-implant 3-wall defect was created around one of the implants. Thermocouples were placed at coronal (T1/T2) and apical (T3/T4) positions of both implants, and the T5 thermocouple was placed in the pontic. An identical setup was created in the type IV artificial bone. Diode laser irradiation (2 W, noninitiated tips, 320-µm fiber, and noncontact) was performed for 60 sec on each experimental model. This experiment was performed separately with 810- and 980-nm lasers for pulsed and continuous modes. ΔT based on the baseline was recorded during irradiation. Statistical analysis was performed with repeated analysis of variance. Results: Across all experimental models, the recorded ΔT (°) values in T2, T4, and T5 at 10, 30, and 60 sec were significantly less than 10°C (p < 0.001) for both types of bones. For both types of bones, there was a statistically significant ΔT greater than 10°C (p < 0.001) for continuous and pulsed 980-nm irradiation and continuous 810-nm diode laser irradiation after 60 sec. For both 810- and 980-nm lasers, there was a statistically significant ΔT greater than 10°C (p < 0.001) for type I and IV bones under irradiation and only for the type I bone model under pulsed irradiation after 60 sec. Conclusions: Within the limitations of this study, 810- and 980-nm lasers on splinted implants placed in vitro may increase the temperature on adjacent splinted implants due to material conductivity and splinting. Clinicians are advised to keep the temperature lower than the critical threshold following recommended power settings to avoid excessive heat and control complications due to overheating.

Anti-inflammatory effect of salt water and chlorhexidine 0.12% mouthrinse after periodontal surgery: a randomized prospective clinical study.

OBJECTIVES: The purpose of this study was to compare the anti-inflammatory efficacy of sodium chloride- and a 0.12% chlorhexidine mouth rinses in patients undergoing minimal invasive periodontal surgery. MATERIALS AND METHODS: Forty-seven patients with a diagnosis of periodontitis and indication for access flap procedure were randomly selected. Group A: a sodium chloride (salt)water-based mouth rinse (test group) or group B: a 0.12% chlorhexidine mouth rinse (control group) administered after surgery. Gingival Index (GI) were evaluated in the whole mouth and in the surgical site at baseline (T1), a week later (T2), and 12 weeks (T3) after the treatment. Total MMP activity was measured in GCF using a commercial kit and plate reader. Medians of total MMP activity and GI were compared for time intervals T1 vs. T2, T1 vs. T3, and T2 vs T3 using Friedman tests and Wilcoxon signed rank tests, and were also compared between test and control using Mann-WhitneyU tests at each timepoint. RESULTS: The average GI values showed significant differences between baseline and T2 (p = 0.0005) and baseline and T3 (p = 0.003) in the test group. CONCLUSION: The sodium chloride-mouth rinse use after periodontal surgery seems to have similar anti-inflammatory properties as CHX mouth rinse and can be used regularly postoperatively after periodontal surgical procedures. CLINICAL RELEVANCE: The use of salt water mouthwash showed an anti-inflammatory effect similar to CHX 0.12% after minimal invasive periodontal surgery. Salt water mouthwash is accessible to the world population and can contribute on the healing process after periodontal surgery.

Is medication-related osteonecrosis of the jaw associated with tumor necrosis factor-α inhibition?

OBJECTIVE: This article reviews the literature and evidence of the association of medication-related osteonecrosis of the jaw with tumor necrosis factor-α inhibition. METHODS: A systematic review was performed using electronic databases (PubMed, MEDLINE, and Embase) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key terms were used in the search. No restrictions were placed on publication status. Selection criteria comprised all levels of available evidence. Articles in the English language were selected up to and including July 2020. Reference lists of relevant studies were searched for additional articles. Articles were selected on the basis of inclusion and exclusion criteria. Findings from eligible studies were extracted by one reviewer and confirmed by a second. Disagreements were settled through discussion. RESULTS: The initial search of the key terms yielded 2107 articles. There were 1192 articles remaining after removal of duplicates and addition of 6 articles that were hand-selected from among reference lists of relevant studies. There were 12 eligible articles after screening. The full texts were read, and 5 articles were included on the basis of inclusion and exclusion criteria. CONCLUSIONS: Further research is required to determine an association of medication-related osteonecrosis of the jaw and tumor necrosis factor-α inhibition.

Efficacy of photobiomodulation therapy on neurosensory recovery in patients with inferior alveolar nerve injury following oral surgical procedures: a systematic review.

OBJECTIVE: The present systematic review aimed to assess the efficacy of photobiomodulation (PBM) therapy on neurosensory recovery of patients with inferior alveolar nerve injury following third molar surgery or dental implant placement. METHOD AND MATERIALS: An electronic search was carried out in Scopus, Embase, Medline, PubMed, Web of Science, Cochrane Library, and Google Scholar databases. Among 1,122 identified papers, seven articles (three RCTs, one observational study, and three case series) met the inclusion criteria.
Results: Time lapse from nerve injury to the onset of PBM therapy varied widely from 2 days to 4 years. The number of patients in each study ranged between 4 and 74. In the majority of the studies, PBM was done using a diode laser at wavelengths ?in the range of 808 to 830 nm with power of 5 to 500 mW and radiation dose of 3 to 244 J/cm2. Two out of three RCTs found significant neurosensory recovery in the patients who received PBM therapy compared to the controls. The observational study and all case series reported significant improvement in the neurosensory status following PBM therapy. The degree of neurosensory recovery was found to be greater in younger patients and those who received the treatment within 6 months following the injury.
Conclusions: Due to the limited number of well-designed RCTs and small number of patients in each study, it is not possible to make a clear conclusion about the efficacy of PBM therapy on neurosensory recovery in patients with inferior alveolar nerve injury following third molar or implant procedures. Considering the possibility of spontaneous inferior alveolar nerve recovery during this period, the conclusion based on the studies with no control group should be interpreted with caution. (Quintessence Int 2021;52:140-153; doi: 10.3290/j.qi.a45430).